A gastroenterologist is a physician who specializes in the diagnosis and treatment of disorders of the gastrointestinal tract, including the esophagus, stomach, small and large intestines, pancreas, liver gallbladder and billary system. A gastroenterologist must first complete an internship and a 2 to 3-year internal medicine residency and is then eligible for additional specialized training in Gastroenterology. This fellowship is generally 2 to 3 years long, so by the time gastroenterologists have completed training, they have had 5 to 6 years of additional specialized education following medical school.
A colonoscopy typically lasts between 15 and 30 minutes. When complete, a nurse will take the patient into a recovery area, where the sedation quickly wears off.
A colon polyp is a small clump of cells that forms on the colon lining. Colon polyps can be raised or flat. Anyone can develop colon polyps. Many middle-aged and older adults have one or more colon polyps, though you’re at a higher risk if you are 50 or older, are overweight or a smoker, eat a high-fat, low-fiber diet, or have a personal or family history of polyps or colon cancer. It’s important to remember that the great majority of colon polyps are harmless, but some can become cancerous over time. Screening is especially important because most polyps don’t cause symptoms. In most cases, the doctor removes colon polyps during flexible sigmoidoscopy or colonoscopy, and then tests them for cancer.
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Colon cancer forms in the tissues of the colon, which is the largest part of the intestine. Most colon cancers begin in cells that make and release mucus and other fluids to aid in digestion and the elimination of waste products.
Though scientists are unsure of the exact causes of colon and colorectal cancer, some risk factors have been identified, including being over age 50, presence of polyps, a high-fat diet, family or personal history of colon cancer, ulcerative colitis, Crohn’s Disease or other inflammatory bowel diseases, a sedentary lifestyle, diabetes, obesity, smoking and alcohol, growth hormone disorder and radiation therapy for cancer.
Screenings, such as flexible sigmoidoscopy and colonoscopy, can help detect cancer or other ailments in the early stages, before symptoms appear. When abnormal tissue or cancer is found early, it may be easier to treat. By the time symptoms appear, cancer may have begun to spread.
If a screening test result is abnormal, you may need to have more tests done to find out if you have cancer. These are called diagnostic tests.
Doctors do not necessarily think their patients have colon cancer if they suggest a colon cancer screening test. Screening tests are given when a person has no cancer symptoms in order to prevent colon cancer or catch it in its earliest stages. Once begun, they are typically repeated on a regular basis, which can vary from one year to every 10 years, depending on the patient’s medical history.
Certain habits, behaviors and environments are considered to be risk factors for colon cancer, based on scientific research. The presence of any of these risk factors may lead doctors to recommend a colonoscopy, which screening tests should be used and how often the tests should be done.
A colonoscopy allows a gastroenterologist to examine the interior lining of the colon and inspect for colon polyps, ulcers, tumors or lesions. If any abnormal tissue is found during the examination, the doctor will remove it immediately. If all looks good after the colonoscopy, the patient won’t have to schedule another one for 10 years.
One of the best benefits of a colonoscopy is that doctors can remove anything suspicious before it even becomes cancerous. The diagnostic and preventative qualities of a colonoscopy make it a powerful weapon to prevent colon cancer.
There are complications with any medical procedure. However, colonoscopies are safe and have minimal risk when performed by gastroenterologists, who have been specially trained and are experienced in these procedures.
One rare but major possible complication is perforation, in which a tear through the colon wall may allow leakage of intestinal fluids. It can be managed with antibiotics and intravenous fluids, although surgery is usually required. Bleeding may occur from the site of biopsy or colon polyp removal. It is usually minor and stops on its own. Rarely, transfusions or surgery may be required.
Localized irritation of the vein can occur at the site of medication injection. A tender lump develops, which may remain for several weeks to several months but goes away eventually. Other risks include drug reactions and complications from unrelated diseases such as heart attack or stroke. Death is extremely rare but remains a remote possibility.
In short, complications from these procedures are extremely rare, but they can happen. Your gastroenterologist can tell you more about colonoscopy risks.
These screenings are a valuable tool for the diagnosis and treatment of many diseases of the large intestine. Abnormalities suspected by X-ray can be confirmed and studied in detail. Even when X-rays are negative, the cause of symptoms such as rectal bleeding or changes in bowel habits may be found by these screenings. Furthermore, while colon cancer is the number three cause of death from cancer, it doesn’t have to be. It is highly preventable with timely screenings.
For the best possible examination, the colon must be completely empty. Patients are asked to temporarily discontinue the use of aspirin products, iron tablets and possibly other medications before the examination.
The gastroenterologist will give detailed colonoscopy prep instructions to follow the day before the procedure, including the use of liquid laxatives and/or pills and fasting that will help ensure your colon is empty of all digested material on the day of the procedure. Patients should inform the gastroenterologist if they’re allergic to any drugs.
Patients will also need someone to drive them to and from the appointment because of the sedation and are not allowed to drive after the colon cancer screening.
Colonoscopy prep is certainly inconvenient, and the laxative materials patients are asked to swallow or drink can make them slightly queasy for a few minutes. This usually does not last long and is a small price to pay to prevent colon cancer.
If prep causes a nauseated feeling, the patient should inform their gastroenterologist. There are other options available next time that might help alleviate that inconvenience. Check out the colonoscopy prep page for tips and tricks to make the prep day more tolerable.
Patients will be monitored until most of the effects of any medication have worn off. Patients may feel bloated and gassy right after the procedure if any air was introduced into the colon. As soon as the procedure has been completed, patients may resume their usual diet unless instructed otherwise. If polyps have been removed, the doctor may suggest a modified diet and probably will advise you to avoid heavy lifting and exercise for several days.
Virtual colonoscopy is slowly becoming available, but it is still in its very early stages, making its availability very limited.
Additionally, a virtual colonoscopy has limitations.
Since colon cancer is the second leading cause of cancer death in the U.S., the recommendation is not to wait to get a colonoscopy if a patient presently meets the screening guidelines. If no colon polyps are found and if this technology progresses, the next colonoscopy could be a virtual colonoscopy.
Many cases of colon cancer have no symptoms or warning signs until the cancer has advanced. That being said, the following symptoms may indicate colon cancer:
Most often, these symptoms are not due to cancer. Other health problems can cause the same symptoms. Anyone with these symptoms should see a doctor to be diagnosed and treated as early as possible.
No one knows the exact causes of colon cancer. Doctors often cannot explain why one person develops this disease and another does not. Research has shown that people with certain risk factors are more likely than others to develop colon cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for colorectal cancer:
Because people who have had colon cancer once may develop it a second time, it is important to have checkups. Also, if a patient is diagnosed they may be concerned that family members may develop the disease. People who think they may be at risk should talk to their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.
But keep in mind that while risk factors can increase an individual’s possibility of getting colon cancer, about 75 percent of those who are diagnosed with it have no family history and no apparent symptoms.
In the United States, colorectal cancer is the fourth most common cancer in men, after skin, prostate and lung cancer. It is also the fourth most common cancer in women, after skin, breast and lung cancer.
Getting screened is the first step in preventing colon cancer. Screening should begin at age 50 for people without any risk factors for developing colon cancer. Recent studies suggest that African-Americans may want to start screening at age 45. There are also certain lifestyle changes that can be made to prevent colon cancer such as leading an active lifestyle and eating a diet high in fiber and fruits and vegetables.
Several screening options are available, including colonoscopy and flexible sigmoidoscopy. More frequent and earlier screening is recommended if you are at a high risk for colon cancer. Remember that these procedures not only detect cancer, but can prevent it, by removing any tissue that could potentially become cancer, in the same procedure.
Treatment options for colon cancer depend on the following:
The three primary treatment options available for colon cancer are surgery, chemotherapy and radiation. The surgical option, a partial colectomy, is the main treatment and includes removing the affected portion of the colon. How much of the colon is removed and whether it is done in conjunction with other treatments will depend on the location of the cancer, how deep it has penetrated the wall of the bowel and if it has spread to the lymph nodes or other parts of the body. Chemotherapy can be used after surgery to destroy any remaining cancer cells, and may be recommended by the doctor if the cancer has spread beyond the colon. Chemotherapy can be used in conjunction with radiation. Radiation therapy uses powerful energy sources to kill any cancer cells that may remain after surgery or to shrink large tumors before an operation. This option is rarely used in early stages of colon cancer.
Check out our Digestive Health Additional Resources section.
Check out our Digestive Health Additional Resources section.
Colonoscopy isn’t the only option for colon cancer screening, but it’s considered the best. Other screening options for colorectal cancer include flexible sigmoidoscopy, virtual colonoscopy, fecal occult blood test and double-contrast barium enema.
A colonoscopy is considered the most accurate. It detects more cancers, examines the entire colon, and can be used for screening, diagnosis and removing polyps in the same procedure. If polyps are detected outside of a colonoscopy, it’s likely that your patient will have to go through the prep again and have a colonoscopy anyway — so a colonoscopy usually makes the most sense.
Having good digestive health means the body is working properly to break down food and turn it into energy — so nutrition is critical. Tell your patients to try these tips:
We appreciate your referral and know how important follow-up is to you and your patients. That’s why we send you all necessary reports and immediately let you know if pathology is found. You should also keep in mind the benefits for your patients: shorter waits, less congestion, easy parking. An ambulatory surgery center is a more pleasant, relaxed environment than a hospital at a much lower cost to your patients. By choosing an ASC, you’re choosing the same high-quality care in a relaxed environment devoted to individualized patient attention.
Guidelines generally recommend colon cancer screenings begin at age 50, but you should evaluate each patient based on their ethnicity and other risk factors, such as family history of the disease. Experts now recommend that African-Americans begin screening at age 45 across the board.
Some colon polyps are benign, which means they are not cancer. But some types of polyps may already be or can become cancer. It’s important not to panic. They are fairly common in adults, which is why screening is so important. Doctors usually remove colon polyps during a colonoscopy because some of them can turn into colon cancer. Whether or not the polyp is cancerous, it’s important that your loved one have follow-up testing to look for more polyps.
The procedure itself takes 15 to 30 minutes. Even though the patient will feel fine, the lingering, subtle effects of the sedation will make it dangerous for them to drive, so a responsible adult must be there to take them home. They should be able to resume normal activities the next day. Patients may feel some cramping or the sensation of having gas after the exam is completed because of the air used to inflate the colon. This bloated feeling usually stops within an hour.
A responsible driver with a valid driver’s license must be available to drive our patients home if they have received sedation medication that will impair their ability to drive for 24 hours. The driver should stay at our facility during the procedure. If they don’t have a driver, we will have to reschedule the procedure for a time when they can have an available driver.
Check out our Digestive Health Additional Resources section.